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      Association of Early Physical Therapy With Long-term Opioid Use Among Opioid-Naive Patients With Musculoskeletal Pain

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          Abstract

          Key Points Question Is early physical therapy associated with long-term opioid use by patients with musculoskeletal pain? Findings In this cross-sectional analysis of 88 985 patients with shoulder, neck, knee, or low back pain, early physical therapy was associated with an approximately 10% statistically significant reduction in subsequent opioid use. Meaning By serving as an alternative or adjunct to short-term opioid use for patients with musculoskeletal pain, early physical therapy may play a role in reducing the risk of long-term opioid use.

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          Implications of early and guideline adherent physical therapy for low back pain on utilization and costs

          John Childs, Julie M Fritz, Samuel S. Wu … (2015)
          Background Initial management decisions following a new episode of low back pain (LBP) are thought to have profound implications for health care utilization and costs. The purpose of this study was to evaluate the impact of early and guideline adherent physical therapy for low back pain on utilization and costs within the Military Health System (MHS). Methods Patients presenting to a primary care setting with a new complaint of LBP from January 1, 2007 to December 31, 2009 were identified from the MHS Management Analysis and Reporting Tool. Descriptive statistics, utilization, and costs were examined on the basis of timing of referral to physical therapy and adherence to practice guidelines over a 2-year period. Utilization outcomes (advanced imaging, lumbar injections or surgery, and opioid use) were compared using adjusted odds ratios with 99% confidence intervals. Total LBP-related health care costs over the 2-year follow-up were compared using linear regression models. Results 753,450 eligible patients with a primary care visit for LBP between 18–60 years of age were considered. Physical therapy was utilized by 16.3% (n = 122,723) of patients, with 24.0% (n = 17,175) of those receiving early physical therapy that was adherent to recommendations for active treatment. Early referral to guideline adherent physical therapy was associated with significantly lower utilization for all outcomes and 60% lower total LBP-related costs. Conclusions The potential for cost savings in the MHS from early guideline adherent physical therapy may be substantial. These results also extend the findings from similar studies in civilian settings by demonstrating an association between early guideline adherent care and utilization and costs in a single payer health system. Future research is necessary to examine which patients with LBP benefit early physical therapy and determine strategies for providing early guideline adherent care. Electronic supplementary material The online version of this article (doi:10.1186/s12913-015-0830-3) contains supplementary material, which is available to authorized users.
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            Does adherence to the guideline recommendation for active treatments improve the quality of care for patients with acute low back pain delivered by physical therapists?

            Julie M Fritz, S. J. Cleland, P Brennan (2007)
            Numerous practice guidelines have been developed for patients with low back pain in an attempt to reduce inappropriate variations and improve the cost-effectiveness of care. Guideline implementation has received more research attention than the impact of adherence to guideline recommendations on outcomes and costs of care. Examine the association between adherence to the guideline recommendation to use active versus passive treatments with clinical outcomes and costs for patients with acute low back pain receiving physical therapy. Retrospective review of patients with acute low back pain receiving physical therapy in 2004-2005. Adherence to the recommendation for active treatment was determined from billing records. Clinical and financial outcomes were compared between patients receiving adherent or nonadherent care. A total of 1190 patients age 18-60 years old with low back pain of less than 90 days duration in 10 clinics in 1 geographic region. Clinical outcomes included the numeric pain rating and Oswestry disability questionnaire taken initially and at the completion of treatment. Financial outcomes included the number of sessions and charges for physical therapy care. Adherence rate was 40.4%. Adherence was greater for patients receiving workers' compensation (P < 0.05). Patients receiving adherent care had fewer visits and lower charges (P < 0.05), and showed more improvement in disability [adjusted mean difference for percentage improvement 25.8%, 95% confidence interval (CI): 21.3-30.4, P < 0.001] and pain (adjusted mean difference for percentage improvement 22.4%, 95% CI: 17.5-27.3, P < 0.001). Patients receiving adherent care were more likely to have a successful physical therapy outcome (64.7% vs. 36.5%, P < 0.001). Adherence to the guideline recommendation for active care was associated with better clinical outcomes and reduced cost.
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              Early Physical Therapy vs Usual Care in Patients With Recent-Onset Low Back Pain

              Julie M Fritz, John Magel, Molly L McFadden … (2015)
              Low back pain (LBP) is common in primary care. Guidelines recommend delaying referrals for physical therapy.
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                Author and article information

                Journal
                Title: JAMA Network Open
                Abbreviated Title: JAMA Netw Open
                Publisher: American Medical Association (AMA)
                ISSN (Electronic): 2574-3805
                Publication date Created: December 07 2018
                Publication date (Electronic): December 14 2018
                Volume: 1
                Issue: 8
                Page: e185909
                Affiliations
                [1 ]Department of Health Research and Policy, Stanford University School of Medicine, Stanford University, Stanford, California
                [2 ]Department of Anesthesiology, Pain, and Perioperative Medicine, Stanford University School of Medicine, Stanford, California
                [3 ]Center for Health Policy, Stanford University School of Medicine, Stanford, California
                [4 ]Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, California
                [5 ]Duke Clinical Research Institute, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina
                Article
                DOI: 10.1001/jamanetworkopen.2018.5909
                SO-VID: 04afa79e-9f15-4d90-8a3d-a7f33ce840a9
                Copyright © © 2018
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